Some surgeons use adjustable sutures (Video 14-5) to avoid an immediately obvious poor result or to increase the likelihood of success with 1 operation, but this modification does not ensure long-term satisfactory alignment. The surgeon completes the operation using externalized sutures and slip knots that enable the position of the surgical muscle to be altered during the early postoperative period. This technique can be used in children; however, general anesthesia is usually required.
Another alternative, used mainly in adults, is performance of surgery with the patient awake. Anesthetic agents that might affect ocular motility are avoided, and the patient’s dynamic ocular motility and ocular alignment are observed and adjusted at the time of surgery. This technique can be difficult in patients with significant scarring, individuals with thyroid eye disease, and children.
Adjustable sutures for extraocular rectus muscles.
Courtesy of Scott A. Larson, MD.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.